The ECG : A Two-Step Approach to Diagnosis. Foreword by Christopher P. Cannon (2004. XXXIV, 615 p. w. 1154 figs. 25 cm)

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The ECG : A Two-Step Approach to Diagnosis. Foreword by Christopher P. Cannon (2004. XXXIV, 615 p. w. 1154 figs. 25 cm)

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  • 製本 Hardcover:ハードカバー版/ページ数 600 p., 590 illus.
  • 商品コード 9783540008699

基本説明

Features: Well structured chapters divided into special sections for "busy readers" and "advanced readers". Chapters illustrated by over 50 short stories/case reports.

Full Description


Professor Gertsch covers both clinically relevant ECGs and very interesting rarer cases of the normal and the exercise ECG, making this work extremely comprehensive - it represents the culmination of a lifetime of involvement with invasive and non-invasive cardiology by one of Switzerland's leading cardiologists. Numerous ECGs and two-color drawings illustrate the text, which is also brought closer to the reader by means of over fifty case reports.Ease of reference is facilitated by the division of the text into separate sections: "At a Glance" for readers who want quick information, and "The Full Picture" for readers wishing to go into exhaustive detail.Foreword by Christopher Cannon.

Table of Contents

Foreword                                           vii
Preface ix
Introduction by Bernhard Meier x
Acknowledgements xi
Abbreviations xxxiii
Section I Theoretical Basics and Practical
Approach
Introduction and Concept of the Book 1 (2)
Introduction 1 (1)
The Value of 'the ECG' Today 1 (1)
Limitations of the Pattern ECG 1 (1)
Conclusions 2 (1)
Concept of the Book 2 (1)
Chapter 1
Theoretical Basics 3 (10)
1 Anatomy of the Impulse Formation and 3 (1)
Impulse Conduction systems
2 Normal Impulse Conduction 3 (1)
3 Action Potential of a Single Cell of 4 (1)
Working Myocardium and its Relation to
Ion Flows
4 Atrial Depolarization and Repolarization 5 (1)
5 Ventricular Depolarization and 6 (1)
Repolarization
5.1 Vectors and Vectorcardiogram 6 (1)
5.2 Simplified QRS Vectors 6 (1)
6 Lead Systems 7 (1)
7 'Magnifying Glass' and 'Proximity' 7 (2)
Effects
8 Refractory Period 9 (1)
9 Nomenclature of the ECG 9 (2)
References 11 (2)
Chapter 2
Practical Approach 13 (5)
1 The Practical Approach 14 (2)
1.1 Definitive ECG diagnosis 15 (1)
2 Practical approach 16 (3)
2.1 Analysis of rhythm 16 (1)
2.2 Detailed analysis of morphology 17 (1)
References 18 (1)
Section II Pattern ECG
Chapter 3
The Normal ECG and its (Normal) Variants 19 (26)
1 Components of the Normal ECG 19 (8)
1.1 sinus Rhythm 19 (1)
1.1.1 Atrial Vectors in Sinus Rhythm 20 (1)
1.2 PQ Interval 21 (1)
1.3 QRS complex 21 (1)
1.3.1 QRS Axis in the Frontal Plane 21 (1)
(AQRSF)
1.3.2 QRS Axis in the Horizontal Plane 22 (1)
1.3.3 Two Special QRS Patterns 22 (1)
1.3.4 Other Normal Variants of the QRS 22 (1)
Complex
1.4 ST Segment 23 (1)
1.4.1 Common Pattern of ST elevation: 23 (1)
ST elevation in V2/V3
1.4.2 Rare Pattern of ST Elevation: 24 (1)
Early Repolarization
1.5 T Wave and U Wave 24 (1)
1.5.1 T Wave 24 (1)
1.5.2 U Wave 25 (1)
1.6 QT Interval 25 (1)
1.7 Arrhythmias 25 (1)
1.8 Day-to-Day and Circadian Variation 26 (1)
General Conclusion 27 (1)
References 27 (18)
Chapter 4
Atrial Enlargement and Other Abnormalities 45 (8)
of the p Wave
1 Left Atrial Enlargement (p Mitrale) 45 (1)
2 Right Atrial Enlargement (p Pulmonale) 45 (1)
3 Biatrial Enlargement (p Biatriale) 45 (1)
4 Acute Left Atrial Overload 46 (1)
5 Acute Right Atrial Overload 46 (1)
6 Other Abnormalities of the p Wave 46 (1)
7 Etiology, Prevalence and Clinical 46 (1)
Significance of Left Atrial Enlargement
8 Etiology, Prevalence and Clinical 47 (1)
Significance of Right Atrial Enlargement
9 Vectors in Left Atrial Enlargement 47 (1)
10 Vectors in Right Atrial Enlargement 47 (1)
11 Special Alterations of the p Wave 47 (1)
11.1 So-called 'p Pulmonale Vasculare' 47 (1)
11.2 p Pseudo-Pulmonale 48 (1)
11.3 Imitation of p Pulmonale 48 (1)
11.4 p Biatriale/Biatrial Enlargement 48 (1)
11.5 Other Uncommon p Configurations in 48 (1)
Sinus Rhythm
11.5.1 Negative p Wave in Lead I 48 (1)
11.5.2 Ebstein's Anomaly 48 (1)
11.5.3 Atrial Infarction 48 (1)
11.5.4 Tricuspid Atresia 48 (1)
References 48 (5)
Chapter 5
Left Ventricular Hypertrophy 53 (22)
1 ECG Indices for LVH 53 (1)
2 Diagnosis of LVH in Intraventricular 54 (1)
Conduction Disturbances
3 Etiology and Prevalence 54 (1)
4 Validation of the QRS Voltage Criteria 55 (1)
5 Detection of LVH in Ventricular 55 (3)
Conduction Disturbances
5.1 Right Bundle-Branch Block 56 (1)
5.2 Left Bundle-Branch Block 57 (1)
5.3 Left Anterior Fascicular Block 57 (1)
5.4 Other Ventricular Conduction 58 (1)
Disturbances
6 Detection of LVH in Special Conditions 58 (1)
6.1 Hypertrophic Obstructive 58 (1)
Cardiomyopathy
6.2 Asymmetrical Apical LVH 59 (1)
6.3 Systolic and Diastolic Overload 59 (1)
6.4 LVH Associated with Marked LV 59 (1)
Dilatation
7 Factors Impairing the ECG Diagnosis of 59 (1)
LVH
7.1 Gender and Race 59 (1)
7.3 Body Habitus and Body Weight 59 (1)
7.4 Other Pathologic Conditions 59 (1)
7.5 Variability of the Frontal and 60 (1)
Horizontal QRS Vector
8 Conclusions 60 (1)
9 Pathophysiology and Effects of LVH on 60 (1)
the ECG
10 Prognosis of LVH 60 (1)
References 60 (15)
Chapter 6
Right Ventricular Hypertrophy 75 (14)
1 ECG Conditions for RVH 75 (1)
1.1 RVH without RV Conduction 75 (1)
Disturbance
1.2 RVH with iRBBB (QRS Duration Normal) 75 (1)
1.3 RVH with RBBB (QRS Duration > 0.12 76 (1)
sec)
2 Etiology and Prevalence 76 (1)
3 Vectors in RVH 76 (1)
4 RVH in the ECG 77 (1)
4.1 Single R Wave, QR Complex or RS 77 (1)
Complex in Lead V
4.2 Incomplete Right Bundle-Branch Block 77 (1)
4.3 Complete Right Bundle-Branch Block 77 (1)
4.4 SI/SII/SIII Type 77 (1)
4.5 Rare Type of RVH 78 (1)
4.6 P Wave Alterations 78 (1)
5 Differential Diagnosis of Possible 78 (1)
Signs of RVH
5.1 Frontal QRS Right-Axis Deviation 78 (1)
5.2 qR Type in Lead V1 78 (1)
5.3 Tall R Wave and RS Complex in Lead 78 (1)
V1
5.4 Incomplete Right Bundle-Branch Block 79 (1)
5.5 Complete Right Bundle-Branch Block 79 (1)
5.6 SI/SII/SIII Type 79 (1)
6 Systolic and Diastolic Overload 79 (1)
7 Effect of Systolic Pressure in the 79 (1)
Right Ventricle and Pulmonary Artery on
the ECG
References 79 (10)
Chapter 7
Biventricular Hypertrophy 89 (1)
1 Usual ECG Signs for BVH 90 (1)
2 Other ECG Signs for BVH 90 (5)
2.1 Shallow SV1,Deep SV2 90 (1)
2.2 Katz-Wachtel Sign 90 (1)
2.3 Special QRS Pattern in Right 90 (1)
Bundle-Branch Block
References 90 (5)
Chapter 8
Pulmonary Embolism 95 (10)
1 ECG Alterations 95 (1)
1.1 Alterations of QRS 95 (1)
1.2 Alterations of Repolarization 95 (1)
1.3 Rhythm Disturbances 95 (1)
1.4 Alterations of the P Wave 95 (1)
2 Value of ECG in Suspected Acute PE 96 (1)
2.1 Differentiation of AMI from Acute PE 96 (1)
2.2 Analysis of Heart Rhythm and 96 (1)
Conduction Disturbances
2.3 ECG Signs of Acute RV Overload 96 (1)
2.4 Control of Clinical Evolution 97 (1)
2.5 Subacute and Chronic repetitive PE 97 (1)
3 Prevalence of ECG Signs suggesting PE 97 (1)
4 ECG Signs and Grade of Acute PE 98 (1)
5 Practical Procedures in suspected Acute 98 (1)
PE
6 ECG in Subacute PE 99 (1)
7 Historical Perspective 99 (1)
References 100 (5)
Chapter 9
Fascicular Blocks 105 (12)
Etiology and Prevalence 105 (1)
1 Left Anterior Fascicular Block 105 (1)
2 Left Posterior Fascicular Block 105 (1)
3 Intraventricular Conduction System 106 (1)
Anatomy
4 Etiology of Fascicular Blocks 106 (1)
4.1 Etiology of LAFB 106 (1)
4.2 Etiology of LPFB 107 (1)
5 Left Anterior Fascicular Block 107 (2)
5.1 Vectors and the ECG 107 (1)
5.2 Variants 108 (1)
5.3 Prognosis 109 (1)
6 Left Posterior Fascicular Block 109 (2)
6.1 Vectors and the ECG 109 (1)
6.2 Special Remarks: AQRSF, ECG 109 (1)
Patterns and Etiology
6.3 Prognosis 110 (1)
7 Very Rare Patterns of Fascicular Blocks 111 (1)
7.1 LAFB plus LPFB 111 (1)
7.2 Left Septal Fascicular Blocks 111 (1)
7.3 Right Fascicular Blocks 111 (1)
References 111 (6)
Chapter 10
Bundle-Branch Blocks (Complete and 117 (14)
Incomplete)
1 Complete Right Bundle-Branch Block 117 (1)
2 Incomplete Right Bundle-Branch Block 118 (1)
3 Complete Left Bundle-Branch Block 118 (1)
4 Incomplete Left Bundle-Branch Block 118 (1)
5 Etiology and Prevalence 118 (1)
6 Complete Right Bundle-Branch Block 119 (1)
6.1 QRS Vectors 119 (1)
6.2 Repolarization Vectors 120 (1)
6.3 Determination of Frontal QRS Axis 120 (1)
in RBBB
6.4 Myocardial Infarction in RBBB 120 (1)
6.5 Right Ventricular Hypertrophy in 120 (1)
RBBB
7 Incomplete Right Bundle-Branch Block 120 (1)
8 Complete Left Bundle-Branch Block 121 (1)
8.1 QRS Vectors 121 (1)
8.2 Repolarization Vectors 122 (1)
8.3 Determination of Frontal QRS Axis 122 (1)
in LBBB
8.4 Myocardial Infarction in LBBB 122 (1)
8.5 Left Ventricular Hypertrophy in LBBB 122 (1)
8.6 Incomplete Left Bundle-Branch Block 122 (1)
9 Special Aspects of Bundle-Branch Blocks 122 (1)
9.1 Rate-Dependent Bundle-Branch Block 122 (1)
9.2 Alternating, Intermittent and 122 (1)
Reversible BBB
9.3 Difference of QRS and QT Duration 123 (1)
in RBBB and LBBB
10 Prognosis 123 (1)
References 123 (8)
Chapter 11
Bilateral Bifascicular (Bundle-Branch) 131 (14)
Blocks
1 RBBB + LAFB 131 (1)
2 RBBB + LPFB 132 (1)
3 Prognosis 132 (1)
4 Etiology 132 (1)
5 Differential Diagnosis of RBBB + LAFB 133 (1)
6 Differential Diagnosis of RBBB + LPFB 133 (1)
7 Differential Diagnosis of RBBB + LAFB + 133 (1)
LPFB Without Complete AV Block
8 Prognosis 134 (1)
9 Indications for Pacemaker Implantation 134 (1)
References 134 (11)
Chapter 12
Atrioventricular Block and Atrioventricular 145 (22)
Dissociation
1 Anatomic Localization of AV Block 145 (1)
2 Degrees of AV Block 145 (2)
2.1 AV block 1ー 145 (1)
2.2 AV block 2ー 146 (1)
2.2.1 AV block 2ー Type Wenckebach 146 (1)
2.2.2 AV block 2ー Type Mobitz 146 (1)
2.2.3 AV block 2ー Type Advanced 146 (1)
2.3 Complete AV Block 146 (1)
2.4 Types of Complete AV Block 146 (1)
2.4.1 Infra-His Complete AV Block 146 (1)
2.4.2 Supra-His Complete AV Block 147 (1)
3 AV Dissociation 147 (1)
3.1 Three Types of AV Dissociation 147 (1)
3.1.1 AV Dissociation with Accrochage 147 (1)
3.1.2 Isorhythmic AV Dissociation 148 (1)
3.1.3 AV Dissociation with Interference 148 (1)
4 Nomenclature and its implications 148 (1)
4.1 Differences Between Complete AV 148 (1)
Block and AV Dissociation
4.2 Pathophysiology and the ECG 148 (1)
4.3 Clinical significance 149 (1)
5 Atrioventricular Block 149 (5)
5.1 AV Block lー 149 (1)
5.1.1 Hemodynamica in AV Block 1ー 149 (1)
5.2 AV block 2ー 149 (1)
5.2.1 AV Block 2ーType Wenckebach 150 (1)
5.2.2 AV Block 2ー Type Mobitz 150 (1)
5.2.3 AV Block 2ー Type Advanced (High 151 (1)
Degree)
5.3 AV Block 3ー 151 (1)
5.3.1 Simultaneous Supra-His AV Block 152 (1)
and Bundle-Branch Block
5.3.2 AV Blocked Atrial Premature Beats 152 (1)
5.3.3 Development of Complete AV Block 152 (1)
5.3.4 Etiology and Clinical 153 (1)
significance of Complete AV Block
5.3.5 His Bundle Derivations 154 (1)
5.3.6 ECG and Anatomical Lesions 154 (1)
5.3.7 Therapeutic Conclusions 154 (1)
6 Special AV Dissociation 154 (1)
6.1 Special Conditions in AV 154 (1)
Dissociation
6.1.1 AV Dissociation in a 154 (1)
Postextrasystolic Beat
6.1.2 Ventriculophasic Sinus Arrhythmia 155 (1)
6.1.3 AV Dissociation in Ventricular 155 (1)
Tachycardia
References 155 (12)
Chapter 13
Myocardial Infarction 167 (98)
Etiology 167 (1)
1 ST Vectors, Q Vectors and T Vectors 167 (1)
2 Stages of Myocardial Infarction 168 (1)
2.1 Acute stage 168 (1)
2.2 Subacute stage 168 (1)
2.3 Old (Chronic) Stage 168 (1)
3 Localization of Q-Wave Infarction 169 (3)
3.1 Anteroseptal Infarction 169 (1)
3.2 Extensive Anterior (Anterolateral) 169 (1)
Infarction
3.3 Lateral Infarction (Isolated MI of 169 (1)
the Lateral Wall)
3.4 Inferior Infarction 169 (1)
3.5 Posterior ('True' Posterior) 169 (2)
Infarction
3.6 Right Ventricular Infarction 171 (1)
4 Differential Diagnosis of 'Classical' 172 (1)
Infarction Patterns (Pathologic Q waves,
ST Elevation, Abnormal T Waves)
5 Complex Infarction Patterns 173 (1)
6 Special Infarction Patterns 174 (1)
Conclusion 174 (1)
7 Etiology and Prevalence 175 (1)
7.1 Arteriosclerotic Coronary Artery 175 (1)
Disease (Common)
7.2 Congenital Coronary Artery Disease 175 (1)
(Rare)
7.3 Other Conditions of Coronary Artery 175 (1)
Disease (Rare)
8 Nomenclature of Infarction stages 176 (1)
8.1 Electropathophysiologic Evolution 176 (1)
8.2 International Terminology 177 (1)
8.3 Histopathologic Evolution 177 (1)
8.4 Clinical Findings and Practical 177 (1)
Experience
9 Combination of Infarction Patterns 177 (1)
9.1 Infarction of Adjacent Areas 177 (1)
9.2 Infarction of Separate or Opposite 178 (1)
Localization
10 Complex Infarction Patterns 178 (3)
10.1 Infarction Associated with Right 178 (1)
Bundle-Branch Block
10.2 Infarction Associated with Left 179 (1)
Bundle-Branch Block
10.2.1 Infarction in Pacemaker Patients 180 (1)
10.3 Infarction in Left Anterior 180 (1)
Fascicular Block
10.4 Infarction in Left Posterior 181 (1)
Fascicular Block
10.5 Infarction in Bilateral Block 181 (1)
10.5.1 Infarction in RBBB + LAFB 181 (1)
10.5.2 Infarction in RBBB + LPFB 181 (1)
11 Special Infarction Patterns 181 (3)
11.1 The So-Called Non-Q-Wave Infarction 181 (1)
11.2 Infarction with ST depression >_ 3 182 (1)
mm
11.3 Infarction with 'Nonsignificant' Q 182 (1)
Waves at Usual Localization
11.4 Infarction with 'Nonsignificant' Q 183 (1)
Waves at Unusual Localization
11.5 Infarction with RSR' Type in 183 (1)
Precordial (and Inferior) Leads
11.6 Infarction with Pure or 183 (1)
Predominant Reduction of R Wave
Amplitude
11.7 Atrial Infarction 183 (1)
12 Differential Diagnosis of 'Classical' 184 (1)
Q-wave Infarction Patterns
13 Localization of Infarction and 184 (1)
Localization of Coronary Occlusion
14 Estimation of Infarct Size 184 (1)
15 Electropathophysiology 185 (1)
15.1 Acute Stage 185 (1)
15.2 Subacute stage 185 (1)
15.3 Old (Chronic) Stage 185 (1)
16 Complications of Acute MI 186 (1)
16.1 Arrhythmias and Conduction Defects 186 (1)
16.2 Nonarrhythmic Complications 186 (1)
References 186 (79)
Chapter 14
Differential Diagnosis of Pathologic Q waves 265 (18)
Definition of Normal Q Wave 265 (1)
Definition of (Formally) Pathologic Q Wave 265 (1)
1 Myocardial Infarction 265 (1)
1.1 New Q Waves 265 (1)
1.2 ST Elevation 266 (1)
1.3 Negative T Waves 266 (1)
2 Normal Variants 266 (1)
2.1 Frontal Plane 266 (1)
2.2 Horizontal Plane 266 (1)
3 Left Ventricular Hypertrophy 266 (1)
4 False Lead Poling 266 (1)
5 Left Bundle-Branch Block 266 (1)
6 Pre-Excitation (Wolff-Parkinson-White 267 (1)
Syndrome)
7 Hypertrophic Obstructive Cardiomyopathy 267 (1)
8 Congenital Corrected Transposition of 267 (1)
the Great Arteries
9 Situs Inversus 267 (1)
10 Q Waves after Pneumectomy 268 (1)
11 Q Waves in Pneumothorax 268 (1)
12 Q Waves after Pericardectomy 268 (1)
13 Q waves in Amyloidosis of the Heart 268 (1)
14 Pseudo-Q Wave due to Retrograde Atrial 268 (1)
Activation
15 A Rarity: Q Waves in Muscular 268 (1)
Dystrophy Steinert
16 QR Complex in Lead V1 268 (1)
17 Q Wave in Lead V1 in Right Atrial 268 (1)
Dilatation
References 269 (14)
Chapter 15
Acute and Chronic Pericarditis 283 (16)
Etiology 283 (1)
1 Acute Pericarditis 283 (1)
2 Chronic Pericarditis 284 (1)
3 Etiology and Prevalence 284 (1)
4 PQ Depression 284 (1)
5 ST Elevation and ST Vector 284 (1)
6 Differential Diagnosis of Acute 284 (2)
Pericarditis versus Acute MI
6.1 ST Elevation 285 (1)
6.1.1 Amplitude of ST Elevation 285 (1)
6.1.2 Configuration of ST Elevation 285 (1)
6.1.3 ST Elevation in Frontal ECG Leads 285 (1)
and Frontal ST Vector
6.1.4 ST Elevation in Horizontal Leads 285 (1)
6.2 Pathologic Q Wave 286 (1)
6.3 PQ Depression 286 (1)
6.4 T-Wave Negativity 286 (1)
7 General Differential Diagnosis of ST 286 (2)
Elevation
8 Arrhythmias 288 (1)
9 Chronic Pericarditis 288 (1)
10 Cardiac Tamponade 288 (1)
11 Clinical Findings in Acute Pericarditis 288 (1)
References 288 (11)
Chapter 16
Electrolyte Imbalances and Disturbances 299 (24)
1 Hyperkalemia (Hyperpotassemia) 299 (1)
2 Hypokalemia(Hypopotassemia) 299 (1)
3 Hypercalcemia 299 (1)
4 Hypocalcemia 300 (1)
5 Therapy of Potassium Imbalance 300 (1)
5.1 Severe Hyperkalemia 300 (1)
5.2 Severe Hypokalemia 300 (1)
6 Hyperkalemia(Hyperpotassemia) 300 (2)
6.1 Differential Diagnosis of Tall and 301 (1)
Peaked T waves
6.2 Prevalence, Clinical Findings and 301 (1)
Etiology of Hyperkalemia
6.3 Therapy of Severe Hyperkalemia 302 (1)
7 Hypokalemia (Hypopotassemia) 302 (1)
7.1 Pathophysiology of Hyperkalemia and 303 (1)
Hypokalemia
8 Hypercalcemia 303 (1)
9 Hypocalcemia (Isolated or Associated 303 (1)
with Hyperkalemia)
10 Hypomagnesemia 303 (1)
11 Hypermagnesemia 303 (1)
12 Sodium Imbalance 304 (1)
13 New Classification of Antiarrhythmic 304 (1)
Drugs
References 304 (1)
Appendix 1 Etiology 305 (18)
Chapter 17
Alterations of Repolarization 323 (6)
1 ST Segment 323 (1)
1.1 ST Elevation 323 (1)
1.2 ST Depression 323 (1)
2 T Wave 324 (1)
2.1 T Negativity 324 (1)
2.2 T Positivity 324 (1)
3 Special Remarks 325 (1)
3.1 Atypical Behavior of Repolarization 325 (1)
in Acute Myocardial Infarction and
Acute Pericarditis
3.2 Patterns with Prolonged or 325 (1)
Shortened QT Duration
3.3 Giant Negative T Waves 325 (1)
References 326 (3)
Section III Arrhythmias
Chapter 18
Atrial Premature Beats 329 (8)
1 Prevalence and Clinical Findings 330 (1)
2 Therapy 330 (1)
References 331 (6)
Chapter 19
Atrial Tachycardia 337 (10)
1 'Salvos' of Atrial Premature Beats 337 (1)
2 'Benign' Atrial Tachycardia 337 (1)
3 Atrial Tachycardia of Medium Duration 337 (1)
and High Rate
4 'Incessant' Atrial Tachycardia 337 (1)
5 Atrial Tachycardia with 337 (1)
Atrioventricular Block 2ー
6 Multifocal Ectopic Atrial Tachycardia 337 (1)
(Chaotic Atrial Mechanism)
7 Ectopic (Focal) Atrial Tachycardia 338 (1)
8 Atrial Reentry Tachycardia 338 (1)
9 Repetitive Paroxysmal Atrial Tachycardia 338 (1)
10 Paroxysmal Atrial Tachycardia with AV 338 (1)
Block
11 Left Atrial Tachycardia 339 (1)
12 Multifocal Atrial Tachycardia (Chaotic 339 (1)
Atrial Tachycardia)
13 Accelerated Atrial Rhythm 339 (1)
14 Closing Remarks 339 (1)
References 339 (8)
Chapter 20
Atrial Flutter 347 (16)
1 Morphologic Types of Atrial Flutter 347 (1)
1.1 Common Type (Type 1) 347 (1)
1.2 Uncommon Type (Type 2) 347 (1)
2 Nomenclature 348 (1)
3 Etiology 349 (1)
4 Clinical significance 349 (1)
5 Pathophysiology and Therapeutic 350 (1)
Consequences
References 350 (13)
Chapter 21
Atrial Fibrillation 363 (16)
Etiology and Prevalence 363 (1)
1 Hemodynamics 363 (1)
2 Clinical significance 364 (1)
3 Therapy 364 (1)
4 Etiology and Prevalence 364 (1)
5 Aberration in Atrial Fibrillation 365 (1)
5.1 Ashman Beats 365 (1)
5.2 Atrial Fibrillation in 365 (1)
Pre-excitation (Wolff-Parkinson-White
syndrome)
6 Regular Ventricular Action in AF 365 (1)
7 Interatrial Dissociation in AF 366 (1)
8 Differential Diagnosis 366 (1)
9 Electrophysiology 366 (1)
10 Clinical significance 367 (1)
11 Therapy and Prevention 367 (2)
11.1 Electric and Drug Conversion 367 (1)
11.2 Implantable Defibrillator 367 (1)
11.3 Maze Procedure and Catheter 367 (1)
Ablation
11.4 Pacemaker 367 (1)
11.5 Prevention of Recurrent AF 367 (1)
11.6 New-Onset Atrial Fibrillation 367 (1)
11.7 Rate Control 368 (1)
11.8 Prevention of Thromboembolism 368 (1)
11.9 Drug Rate Control versus 368 (1)
Electroconversion
11.10 Final Remarks 369 (1)
References 369 (10)
Chapter 22
Sick Sinus Syndrome (and Carotid Sinus 379 (12)
Syndrome)
1 Characteristics 379 (1)
1.1 Sinus Bradycardia 379 (1)
1.2 Sinus Standstill/Arrest 379 (1)
1.3 Exit Block or Sinoatrial Block 379 (1)
1.4 Bradycardia-Tachycardia Variant 379 (1)
1.5 AV Node and Bundle Branches 380 (1)
2 Clinical significance 380 (1)
3 Prognosis and Complications 380 (1)
4 Therapy 380 (1)
5 Prevalence and Etiology 380 (1)
6 Pseudo versus True Sick Sinus Syndrome 381 (1)
6.1 Influence of Drugs 381 (1)
6.2 Abnormal Vagal Reaction After 381 (1)
Invasive Procedures
6.3 Excessive Sinus Bradycardia in 381 (1)
Athletes
6.4 Atrial Premature Beats with AV Block 381 (1)
6.5 'Laboratory' Sick Sinus Syndrome 382 (1)
6.6 Sinus Nodal Re-entry Tachycardia 382 (1)
7 Hypersensitive Carotid Sinus Syndrome 382 (1)
7.1 Cardioinhibitory Type 382 (1)
7.2 Vasodepressor Type 382 (1)
8 Symptoms and Complications 382 (1)
9 Electrophysiologic Testing 382 (1)
10 Therapy 382 (1)
References 383 (8)
Chapter 23
Atrioventricular Junctional Tachycardias 391 (14)
1 Conduction in Sinus Rhythm 391 (1)
Conduction in AVNRT 391 (1)
3 Common Form of AVNRT 392 (1)
4 Rare Form of AVNRT 392 (1)
5 Differential Diagnosis 393 (1)
5.1 Atrial Flutter 393 (1)
5.2 AV Reentry Tachycardia in the WPW 393 (1)
Syndrome
5.3 Aberration 393 (1)
6 Symptoms of AVNRT (Common Form) 393 (1)
7 Clinical Significance of AVNRT (Common 393 (1)
Form)
8 Etiology and Prevalence 394 (1)
9 Special Types of AV Junctional 394 (1)
Tachycardias
9.1 Accelerated AV Junctional Rhythm 394 (1)
9.2 Automatic Junctional Tachycardia 394 (1)
(AJT)
9.3 Permanent Junctional Reciprocating 394 (1)
Tachycardia (PJRT)
10 Prognosis 395 (1)
11 Therapy of AVNRT (Common Form) 395 (1)
12 Therapy of the Other Types of AV 395 (1)
Junctional Tachycardias
References 395 (10)
Chapter 24
The Wolff-Parkinson-White syndrome 405 (30)
1 Pre-Excitation Pattern (WPW Pattern) 405 (1)
1.1 Nomenclature 405 (1)
1.2 ECG Patterns in Pre-Excitation 406 (1)
1.3 Differential Diagnosis of the WPW 406 (1)
Pattern
1.3.1 Myocardial Infarction 406 (1)
1.3.2 Left Ventricular Hypertrophy 406 (1)
1.3.3 Pseudo-Delta Wave 406 (1)
2 Tachycardias in the WPW Syndrome 406 (2)
2.1 Reentry Tachycardias 406 (1)
2.2 Atrial Fibrillation and Atrial 407 (1)
Flutter in the WPW Syndrome
2.3 Therapy 408 (1)
2.4 Therapeutic Pitfalls 408 (1)
3 Etiology 408 (1)
4 Anatomy and Localization of Accessory 409 (1)
Pathways
4.1 Algorithms 409 (1)
5 Degree of Pre-Excitation, Latent 410 (1)
Pre-Excitation and Concealed Accessory
Pathway
6 Repolarization Abnormalities 411 (1)
7 Differential Diagnosis 411 (1)
8 Tachyarrhythmias Associated with the 411 (2)
Wolff-Parkinson-White Syndrome
8.1 Atrioventricular Reentry Tachycardia 412 (1)
8.2 Other Tachycardias Associated with 413 (1)
an Accessory Pathway
8.2.1 Special Condition: Atrial 413 (1)
Fibrillation
8.3 Ventricular Fibrillation and Sudden 413 (1)
Death
9 Other Accessory Connections 413 (1)
9.1 Mahaim Fibre and Mahaim Tachycardias 413 (1)
9.2 Lown-Ganong-Levine syndrome 414 (1)
10 Therapy of the WPW Syndrome 414 (2)
10.1 Acute Termination of Tachycardia 414 (1)
10.2 Chronic Therapy for Prevention 415 (1)
10.3 Treatment of Patients with an 415 (1)
Asymptomatic WPW Pattern
References 416 (19)
Chapter 25
Ventricular Premature Beats 435 (10)
1 Definition and Nomenclature 435 (1)
1.1 Coupling Interval 435 (1)
1.2 Compensatory Pause 435 (1)
1.3 Morphology and Origin 435 (1)
1.4 Special Types 436 (1)
1.4.1 R-on-T Phenomenon 436 (1)
1.4.2 Interponated VPBs 436 (1)
1.4.3 Fusion Beat 436 (1)
1.4.4 Concealed Bigeminy 436 (1)
2 Differential Diagnosis 436 (1)
3 Mechanism 436 (1)
4 Prognosis 436 (1)
5 Therapy 437 (1)
References 437 (8)
Chapter 26
Ventricular Tachycardia 445 (34)
1 Definition and Characteristics of 445 (1)
Ventricular Tachycardia
2 Types of Ventricular Tachycardia 445 (1)
2.1 Monomorphic VT 445 (1)
2.1.1 Etiology of Monomorphic VT 446 (1)
2.2 Polymorphic VT of Type 'Torsade de 446 (1)
Pointes'
2.2.1 Etiology of Torsade de Pointes VT 446 (1)
2.3 Polymorphic VT (without 'Torsade de 446 (1)
Pointes')
3 A Special Condition: Accelerated 446 (1)
Idioventricular Rhythm
4 Differential Diagnosis of 'Wide QRS' 446 (1)
Tachycardias: VT versus SVT with
Aberration
4.1 Types of SVT with Aberration (SVT 447 (1)
with Wide QRS)
4.1.1 SVTab with Bundle-Branch Block 447 (1)
4.1.2 SVTab in Wolff-Parkinson-White 447 (1)
syndrome
4.1.3 SVT with other Aberrations 447 (1)
4.2 Criteria for Differentiation 447 (1)
Between VT and SVTab
4.3 Criteria for Differentiation 447 (1)
Between VT and Artifacts
5 Therapy 447 (1)
6 Pathophysiology 448 (1)
6.1 Reentry 448 (1)
6.2 Enhanced Automaticity 448 (1)
6.3 Triggered Activity 449 (1)
6.4 Electrotonus 449 (1)
6.5 Onset of VT 449 (1)
7 Types of Ventricular Tachycardia 449 (2)
7.1 Monomorphic VT 449 (1)
7.2 VT of the Type Torsade de Pointes 449 (1)
7.3 Polymorphic VT Without Torsade de 450 (1)
Pointes
7.4 Special Types of VT 450 (1)
7.4.1 Parasystolie VT 450 (1)
7.4.2 Bidirectional VT 450 (1)
7.4.3 Double Tachycardia 450 (1)
7.4.4 Accelerated Idioventricular Rhythm 450 (1)
8 Differential Diagnosis of Regular 451 (1)
Monomorphic 'Wide QRS Complex'
Tachycardias: VT versus SVT with
Aberration
8.1 General Remarks 451 (1)
8.1.1 Age and Prevalence 451 (1)
8.1.2 Underlying Cardiac Disease 451 (1)
9 Electrocardiographic Findings in 451 (3)
Monomorphic VT
9.1 General Findings 451 (1)
9.1.1 AV Dissociation 451 (1)
9.1.2 Fusion Beats and (Ventricular) 451 (1)
Capture Beats
9.1.3. VA Block 2ー 451 (1)
9.1.4 Rate 451 (1)
9.1.5 Regularity 452 (1)
9.1.6 Comparison of 'Wide QRS' 452 (1)
Tachycardia ECG with a Previous ECG
Without Tachycardia
9.2 QRS Criteria 452 (1)
9.2.1 QRS Duration 452 (1)
9.2.2 Frontal QRS Axis 452 (1)
9.2.3 Morphologic QRS Criteria 452 (2)
10 Misdiagnoses of Wide QRS Tachycardias 454 (1)
10.1 VT Misdiagnosed as SVTab 454 (1)
10.2 Differentiation Between Wide 454 (1)
Complex Tachycardias (especially VT)
and Artifacts
11 Final General (and Therapeutic) 455 (1)
Considerations
References 456 (23)
Section IV Special Topics
Chapter 27
Exercise ECG 479 (26)
Information from the Exercise Test 479 (1)
1 Indications and Contraindications 479 (1)
1.1 Indications 479 (1)
1.2 Contraindications 480 (1)
2 Limitations 480 (1)
3 Methods 480 (2)
3.1 Exercise Limited by symptoms 481 (1)
3.2 Heart Rate 481 (1)
3.3 Blood Pressure 481 (1)
3.4 Double Product 481 (1)
3.5 Workload and Exercise Capacity 482 (1)
3.6 Duration of Exercise 482 (1)
3.7 Stepwise Exercise versus the Ramp 482 (1)
Protocol
3.8 Criteria for Interruption of the 482 (1)
Test
4 Procedure 482 (1)
4.1 Exercise Preparation 482 (1)
4.2 Exercise Procedure 483 (1)
5 Validation 483 (2)
5.1 Ischemic Response 483 (1)
5.1.1 ST Segment 483 (1)
5.1.2 T Wave 484 (1)
5.1.3 Q Wave 484 (1)
5.2 Arrhythmias and Conduction 484 (1)
Disturbances
5.3 Pitfalls 485 (1)
6 Complications 485 (1)
6.1 Severe Cardiac Complications 485 (1)
6.2 Severe Noncardiac Complications 486 (1)
6.3 Common Nonsevere Complications 486 (1)
6.4 Rare Nonsevere Complications 486 (1)
7 Specificity and Sensitivity 486 (1)
8 Exercise in Pre-existing Bundle-Branch 487 (1)
Block and Left Anterior Fascicular Block
9 New Bundle-Branch Block During Exercise 487 (1)
10 Ventricular Premature Beats During 487 (1)
Exercise
11 Alterations of QRS During Exercise, 487 (1)
Without Intraventricular Conduction
Disturbances
12 Right Precordial Leads in the Exercise 487 (1)
Test
13 Exercise Test After Aortocoronary 488 (1)
Revascularization
14 Exercise ECG After PTCA 488 (1)
15 Exercise Training in Cardiac 488 (1)
Rehabilitation After MI and
Revascularization
16 Exercise Training in Heart Failure 488 (1)
17 Prognostic Impact of the Exercise Test 488 (1)
References 489 (16)
Chapter 28
Pacemaker ECG 505 (20)
1 single-chamber Pacemaker 505 (1)
2 Dual-chamber Pacemaker 506 (1)
3 Electric Complications and Failures 506 (1)
3.1 Undersensing and Oversensing 506 (1)
3.2 Lead Fracture and Lead Insulation 507 (1)
Damage
4 Pacemaker Codes 507 (1)
5 Morphologic Features 508 (1)
6 Pacemaker-Mediated Arrhythmia 508 (1)
7 Pacemaker Malfunction 509 (1)
7.1 Battery Depletion 509 (1)
7.2 Electrode Problems 509 (1)
7.3 Oversensing and Undersensing 509 (1)
8 Pacemaker syndrome 509 (1)
8.1 Prevalence 509 (1)
8.2 Condition 509 (1)
8.3 Pathophysiologic Mechanisms 510 (1)
9 Indications for Pacing 510 (1)
9.1 Pacing in Hypertrophic Obstructive 510 (1)
Cardiomyopathy
9.2 Pacing in Heart Failure 511 (1)
10 Prognosis of AV Sequential 511 (1)
(Physiologic) Pacing vs single-chamber
Ventricular Pacing
10.1 Conclusions 512 (1)
References 512 (13)
Chapter 29
Congenital and Acquired (Valvular) Heart 525 (10)
Diseases
1 Congenital Heart Diseases 525 (1)
1.1 Atrial Septal Defect of the Ostium 525 (1)
Secundum Type
1.1.1 Differential Diagnosis 525 (1)
1.2 Atrial Septal Defect of the Ostium 526 (1)
Primum Type
1.3 Valvular Pulmonary Stenosis 526 (1)
1.4 Tetralogy of Fallot 526 (1)
1.5 Ventricular Septal Defect 526 (1)
2 Acquired Valvular Diseases 526 (1)
3 Congenital Heart Diseases 526 (1)
3.1 Ductus Arteriosus Botalli 526 (1)
3.2 Eisenmenger Syndrome 526 (1)
3.3 Transposition of the Great Arteries 527 (1)
3.4 Situs Inversus 527 (1)
3.5 Ebstein's Anomaly 527 (1)
3.6 Complex Congenital Cardiac Diseases 527 (1)
3.7 Mitral Valve Prolapse (Barlow's 527 (1)
Disease)
3.8 Hypertrophic Obstructive 527 (1)
Cardiomyopathy (HOCM)
4 Acquired Valvular Heart Diseases 527 (1)
4.1 Valvular Aortic Stenosis 527 (1)
4.2 Valvular Aortic Incompetence 527 (1)
4.3 Mitral Stenosis 527 (1)
4.4 Mitral Incompetence 528 (1)
References 528 (7)
Chapter 30
Digitalis Intoxication 535 (6)
1 Extracardiac Symptoms 535 (1)
2 Electrophysiology and Pharmacokinetics 536 (1)
3 Acute Digitalis Intoxication and its 536 (1)
Therapy
References 537 (4)
Chapter 31
Special ECG Waves, signs and Phenomena 541 (1)
1 Ashman Phenomenon 541 (1)
2 Brugada sign or syndrome 541 (1)
3 Cabrera sign 542 (1)
4 Chatterjee Phenomenon 542 (1)
5 Delta Wave 542 (1)
6 Dressler Beat 543 (1)
7 Early Repolarization 543 (1)
8 Epsilon Wave 543 (1)
9 McGee Index 543 (1)
10 McGinn White Pattern (SI/QIII Type) 543 (1)
11 Katz-Wachtel Sign 543 (1)
12 Nadir sign 543 (1)
13 Osborn Wave 543 (1)
14 Pardee Q Wave 543 (1)
15 R-on-T Phenomenon 544 (1)
16 Shallow s sign 545 (1)
17 Stork Leg sign 545 (1)
Final Comment 545 (1)
References 545 (16)
Chapter 32
Rare ECGs 561 (23)
Multifocal or Chaotic Atrial Rhythm 561 (1)
Absent Pericardium 562 (1)
Right Ventricular Dysplasia 562 (1)
(Arrhythmogenic Right Ventricular
Cardiomyopathy)
Severe Hypertrophic Cardiomyopathy 563 (1)
Strange R Wave in Lead V2 in a Patient 564 (1)
with Severe Hypertrophic Cardiomyopathy
Strange R Wave in Lead V1 in a Patient 565 (1)
without Right Ventricular Hypertrophy or
Posterior Infarction
What is the Rhythm? 565 (3)
After Left Pneumectomy 568 (1)
After Right Pneumectomy 568 (1)
Pneumothorax 569 (1)
Electrical Alternans 570 (1)
Common and Rare False Poling of the Limb 570 (3)
Leads (Lead Displacement) in Frontal QRS
Left Axis and in Frontal QRS Vertical Axis
Situs Inversus 573 (2)
Epileptic Attack of the ECG Machine 575 (1)
Parasystole 575 (1)
Left Pleural Effusion 576 (1)
So-Called Postsyncopal Bradycardia 576 (2)
Syndrome
'Dying Heart' 578 (1)
Two p Waves: Highly specific for a 579 (1)
Transplanted Heart
Pseudo-p Waves in Precordial Leads V3/V4 580 (1)
'Double Ventricular Repolarization' 581 (1)
T Wave without QRS Complex 581 (1)
Double Ventricular Response to a single 582 (1)
Atrial Impulse. Another Artifact?
Another Rare ECG 583 (1)
References 584 (1)
Subject Index 585 (22)
ECG Index 607